Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
J Neurooncol. 2023 Oct;165(1):219-226. doi: 10.1007/s11060-023-04486-1. Epub 2023 Oct 27.
The Warburg Effect, referring to an elevation in serum lactate level attributable to increased tumor metabolism, is present in patients with brain tumors. This study comprehensively analyzes the Warburg effect in patients undergoing brain tumor resection.
We retrospectively analyzed the baseline intraoperative serum lactate levels of 2,053 patients who underwent craniotomies, including 415 with cerebral aneurysms and 1,638 with brain tumors. The brain tumor group was divided into subgroups based on the tumor pathology (extra-axial and intra-axial tumor) and the WHO tumor grade (high-grade and low-grade).
Serum lactate level was significantly higher in the tumor group than in the aneurysm group (1.98 ± 0.97 vs. 1.09 ± 0.57 mmol/L, p < 0.001). The hyperlactatemia incidence (serum lactate level > 2.2 mmol/L) was higher in the tumor group (33.5 vs. 3.1%, p < 0.001). Severe hyperlactatemia (serum lactate level > 4.4 mmol/L) was found in 34 patients (2.1%) of only the tumor group. In patients with intra-axial tumors, serum lactate level was greater in high- than low-grade tumors (2.10 ± 1.05 vs. 1.88 ± 0.92 mmol/L, p = 0.006). Factors predictive of hyperlactatemia included supratentorial tumor location (odds ratio[95%CI] 2.926[2.127-4.025], p < 0.001) and a long tumor diameter (1.071[1.007-1.139], p = 0.028). In high-grade intra-axial brain tumor patients, there was a significant difference in overall survival between patients with hyperlactatemia than those without (p = 0.048).
Our results show that brain tumor patients exhibit the Warburg effect and serum lactate may be a useful diagnostic and prognostic biomarker in patients with high-grade intra-axial brain tumors.
沃伯格效应是指肿瘤代谢增加导致血清乳酸水平升高，存在于脑肿瘤患者中。本研究全面分析了行脑肿瘤切除术患者的沃伯格效应。
我们回顾性分析了 2053 例行开颅术患者的术中基础血清乳酸水平，其中包括 415 例颅内动脉瘤患者和 1638 例脑肿瘤患者。脑肿瘤组根据肿瘤病理（脑外肿瘤和脑内肿瘤）和世界卫生组织肿瘤分级（高级别和低级别）进行分组。
肿瘤组血清乳酸水平明显高于颅内动脉瘤组（1.98±0.97 比 1.09±0.57mmol/L，p<0.001）。肿瘤组高乳酸血症发生率（血清乳酸水平>2.2mmol/L）较高（33.5%比 3.1%，p<0.001）。仅在肿瘤组中发现 34 例（2.1%）严重高乳酸血症（血清乳酸水平>4.4mmol/L）。在脑内肿瘤患者中，高级别肿瘤的血清乳酸水平高于低级别肿瘤（2.10±1.05 比 1.88±0.92mmol/L，p=0.006）。高乳酸血症的预测因素包括幕上肿瘤位置（优势比[95%可信区间]2.926[2.127-4.025]，p<0.001）和肿瘤长径较长（1.071[1.007-1.139]，p=0.028）。在高级别脑内肿瘤患者中，高乳酸血症患者的总生存率与无高乳酸血症患者相比有显著差异（p=0.048）。
我们的研究结果表明，脑肿瘤患者存在沃伯格效应，血清乳酸可能是高级别脑内肿瘤患者有用的诊断和预后生物标志物。
